HC Deb 14 March 1995 vol 256 cc684-6
11. Lady Olga Maitland

To ask the Secretary of State for Health what plans she has to extend general practitioner fundholding; and if she will make a statement.

Mr. Malone

In October 1994 we announced a major extension of the options for general practitioner fundholding, the development of a community option and the expansion of standard fundholding. In addition we continue to look at other services and other ways to develop the benefits that can be achieved through fundholding. Our aim is to extend the benefits for patients as widely as possible.

Lady Olga Maitland

Is my hon. Friend aware that although 30 per cent. of my constituents enjoy the excellent services of GP fundholders, none the less that percentage is below the national average? What steps will he take to ensure that my constituents in Sutton and Cheam enjoy the same benefits as other people who are patients of GP fundholders?

Mr. Malone

I am sure that my hon. Friend will take her own steps, as she regularly does, to ensure that all general practitioners in her constituency are aware that fundholding status is available to them. Under the new scheme, about 85 per cent. of GPs are now eligible for fundholding status, and we fully expect the percentage of the population covered to increase dramatically over the next year or so. We are seeing progress to that end, and we expect that progress to be maintained.

Mr. Austin-Walker

Before extending GP fundholding, will the Minister look back at the answers to the questions that I have asked about it? He replied that he did not hold the information centrally and referred me to the regional health authority and the family health services authority. Is he aware that the regional health authority has given me two different figures covering the constituency of the hon. Member for Sutton and Cheam (Lady Olga Maitland), which in terms of underspending are more than £100,000 apart? For Camden and Islington, the figure given by the regional health authority is almost twice that given by the FHSA. Does the Minister agree that until he can get his house in order, monitor the figures and find out what is happening to the underspend, he should not extend the practice further?

Mr. Malone

Again, the hon. Gentleman is simply trying to deny the fact that fundholding brings additional benefits for patients, and I am surprised that Opposition Members have not caught up with the news.

Mr. Olner

It is a fiddle.

Mr. Malone

The hon. Member had better not say that to the Leader of the Opposition, as the Labour party has now changed its policy on the subject.

The figures taken over time from family health services authorities and the regions will give different snapshots, but they will be consistent once they have worked through the system. I reiterate that funds that are made available for patient care according to plans approved by the region and by fundholding practices have been passed by the Audit Commission. I could not suggest anything to the hon. Gentleman that could be more stringent than that. It is a quite proper use of public funds for patient care.

Mr. Anthony Coombs

As more than 90 per cent. of my constituents will soon be enjoying the benefits of being treated by GP fundholders, does my hon. Friend agree that they will find the remarks of Opposition Members—particularly the hon. Member for Rotherham (Mr. MacShane)—deeply offensive? Does he agree that total fundholding as practised originally in Bromsgrove and now being extended to Bewdley in my constituency is a way forward to make GP fundholders the real gatekeeper of health services and to ensure that those services reach ever-higher standards for patients?

Mr. Malone

My hon. Friend is right. I have visited a number of total fundholding pilot projects, including one in Bath last week which will get under way on 1 April. They are exciting projects that must be evaluated, but remarkable achievements have already been recorded by projects that are under way. Progress to date has been extremely good.

Mrs. Beckett

Is the Minister aware that we receive literally dozens of letters from GPs protesting that, under instructions from Ministers, managers in their areas are attempting to browbeat them into becoming fundholders whether they wish to or not? That view is reflected in a survey in Pulse, which shows that 71 per cent. of GPs do not wish to become fundholders. Has the Minister seen the advertisement that has been placed in East Anglian newspapers by 32 GPs in Suffolk who are not fundholders? The advertisement states that the GPs are saving the Treasury more than £200,000 a year, and that not one penny of that money is available for patient care. Why is the Minister trying to force people to become fundholders when the practice is unproven, inequitable and very expensive?

Mr. Malone

That is marvellous, because the Leader of the Opposition is trying to force the right hon. Member for Derby, South (Mrs. Beckett) to support fundholding practices. We did not hear the right hon. Lady say today whether she agrees with the change in Labour party policy.

There is no question of forcing anybody to become a GP fundholder. Of course, GPs are encouraged to do so because it is the way forward in a primary care-led NHS. The vast majority of GPs who become fundholders—sometimes, I concede to the right hon. Lady, reluctantly—usually end up being in the vanguard of those praising the system and the benefits it can bring, which include an extension of clinical expertise that GPs are able to deploy directly to patients. They are enthusiastic about it, but it is still a voluntary process. I still wish to see more people join the scheme.

Mr. Hayes

In my hon. Friend's busy day—[HON. MEMBERS: "Hear, hear."] I am grateful for the applause. Will my hon. Friend take time to be magnanimous and act as a mediator between the right hon. Member for Derby, South (Mrs. Beckett), the Leader of the Opposition and, I suspect, the deputy leader of the Labour party—

Madam Speaker

Order. The hon. Gentleman must ask a question that relates to ministerial responsibility.

Mr. Hayes

This is precisely to do with GP fundholders and NHS trusts, because the right hon. Lady wants to get rid of them while the Leader of the Opposition wants to keep them. Will my hon. Friend help the right hon. Lady out?

Mr. Malone

I am always prepared to be magnanimous, but I am afraid that I am not prepared to be quite as magnanimous as that.